New diagnostic tool reflectsdiverse Canadianpaediatric population

A major tool has been developed that will directly contribute to improved diagnosis and assessment of children and youth with medical concerns across Canada.

When a child undergoes blood tests to diagnose a specific medical condition, physicians, laboratory specialists and the family have one shared goal: to obtain accurate test results. If the test results are positive, the clinical team can then determine the best treatment options and provide the necessary care.

The ability of lab specialists to interpret the results accurately is dependent upon several important factors, including the availability of accurate reference values, which provide the “normal” result for a healthy child in the general population.

These crucial reference values have existed in Canada, but until now, these numbers have had significant demographic gaps, experts say. Much of the current data is outdated and includes some reference values that were obtained in the 1980s, when the technology was not as advanced as it is today. In addition, there has been a need to obtain a more accurate representation of the current population of children in Canada; including children of all paediatric age groups (birth to 18 years), both genders, and a variety of ethnicities that make up the multicultural Canadian population. These often previously-overlooked factors can affect the interpretation of test results.

A new, comprehensive database of 40 biochemical markers (substances that can be detected in blood, urine or other bodily fluids that can reveal diseases or abnormalities) in an ethnically-diverse Canadian paediatric population is now available to hospitals and paediatricians, and will soon be available to the general public online. A national team of researchers led by The Hospital for Sick Children (SickKids) spent four years developing the tool.

Through the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) Project, healthy children and teens of varying ages, genders and ethnicities were invited to participate. Nearly 2,200 participants, who were recruited through community outreach initiatives, provided blood samples and information that were used to determine reference values for 40 serum biochemical markers.

In a recent online publication of Clinical Chemistry, the CALIPER team reports on the development of this new national database, which is expected to help lab specialists and paediatricians across the country to more accurately interpret test results, which may lead to improved diagnosis and monitoring of childhood diseases.

“Age, gender and ethnicity can profoundly influence levels of biochemical markers,” says Dr. Khosrow Adeli, Head of the Division of Clinical Biochemistry and Senior Associate Scientist at SickKids. “We hope this new database of healthy Canadian children and youth will help improve diagnosis and treatment for a variety of medical conditions. Since treatment can depend upon lab test results – and treatment efficacy is also usually monitored by doing these tests – accurate analysis of these results is critically important.”

“While similar databases exist in the adult population, obtaining sufficient data from a general population of children is much more challenging. This is due to the significant differences between children at different ages,” Dr. Adeli adds. For example, a two-year-old would not have the same results as a 10-year-old or a 17-year-old.

“Kids are constantly growing and changing,” says Adeli, who is also Professor in the Departments of Biochemistry and Laboratory Medicine & Pathobiology at the University of Toronto. “These differences are now documented in a more comprehensive way, which is a major step toward filling the gaps that exist in this area.”

Next steps in this research will include testing study participants for an additional 30 biochemical markers. The scientists will then use transference studies to run tests on different equipment in various hospitals across the country. This would account for any variations between hospitals and help ensure consistent results, regardless of the patient’s geographic location. Moving forward, the database is expected to be updated once every decade to account for technological and population changes.

In addition to SickKids, six other Canadian hospitals from coast to coast are collaborating on the CALIPER Project: Eastern Health/Janeway Children’s Health & Rehabilitation Centre, CHU Sainte-Justine, Children’s Hospital of Eastern Ontario, McMaster Children’s Hospital, Royal University Hospital and BC Children’s Hospital.

For more information about the CALIPER Project, or to participate, visit www.caliperproject.com.

The study was supported by the Canadian Institutes of Health Research, Abbott Diagnostics and SickKids Foundation.

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